Researchers examined data on 12,329 participants in the Hordaland Health Study (mean baseline age 41 years, 52% women) who were grouped by baseline blood pressure status for normotension (less than 130/80 mmHg) or stage 1 (130/80 mmHg - 139/80 mmHg) and stage 2 (at least 140/90 mmHg) hypertension. At baseline, fewer women than men had stage 1 (25% vs 35%) and stage 2 (14% vs 31%) hypertension.
Over a median follow-up period of 16 years, 89 women and 341 men developed acute coronary syndromes (ACS), defined as hospitalization or death with an acute myocardial infarction or unstable angina diagnosis.
Compared with normotensive women, women with stage 1 and stage 2 hypertension were significantly more likely to develop ACS (hazard ratio 2.18 and 3.09, respectively). Men with stage 2, but not stage 1, hypertension were significantly more likely to develop ACS than normotensive men (HR 1.40).
"Since the threshold for high blood pressure is the same in both sexes, young women have in fact had a relatively larger increase in blood pressure than men before being diagnosed with high blood pressure," said lead study author Dr. Ester Kringeland of the Center for Research on Cardiac Disease in Women at the University of Bergen in Norway.
"Young women with stage 1 hypertension may have more advanced disease compared to men with stage 1 hypertension at similar age," Dr. Kringeland said by email.
The study findings may also reflect underlying differences in vascular biology between women and men, related in particular to changes in the small arteries, although this would need to be explored in future research, Dr. Kringeland said.
When researchers categorized participants by systolic or diastolic hypertension, specifically, they found that stage 1 and stage 2 systolic hypertension was not associated with ACS in either sex. With diastolic blood pressure, however, women with stage 1 and stage 2 diastolic hypertension were at significantly greater risk for ACS (HR 2.79 and 5.74, respectively) while only men with stage 2 diastolic hypertension faced a statistically significant increased risk for ACS (HR 1.57).
One limitation of the study is that participants were primarily Caucasians living in Western Norway, and results may not be generalizable to other populations, the authors note in the European Journal of Preventive Cardiology.
The researchers also lacked data on hypertensive disorders during pregnancy.
Even so, the study underscores that high blood pressure in women should not be ignored or its impact under-estimated, said Dr. Vasan Ramachandran, chief of preventive medicine and epidemiology at the Boston University School of Medicine and principal investigator and director of the Framingham Heart Study.
"It warrants screening to detect the condition, regular follow-up with appropriate confirmation after initial detection, subsequent management and control of the elevated blood pressure and also that of the accompanying constellation of other risk factors such as smoking, diabetes and dyslipidemia," Dr. Ramachandran, who wasn't involved in the study, said by email.
Both men and women with stage I hypertension warrant careful follow-up with their health care providers to institute non-pharmacological measures as and pharmacological measures as needed, with regular follow-up, Dr. Ramachandran added.
"Current algorithms for CVD prediction start at age 40 years," Dr. Ramachandran said. "There may be a need to extend such algorithms to younger ages as well for effective CVD prevention in women."
SOURCE: https://bit.ly/2REzTDJ European Journal of Preventive Cardiology, online May 16, 2021.
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